Provider Demographics
NPI:1699789172
Name:OWEN, CLAYTON L (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:L
Last Name:OWEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1106 SOUTH PINE STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023
Mailing Address - Country:US
Mailing Address - Phone:501-941-1700
Mailing Address - Fax:501-941-1703
Practice Address - Street 1:1106 S PINE ST
Practice Address - Street 2:SUITE B
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-3836
Practice Address - Country:US
Practice Address - Phone:501-941-1700
Practice Address - Fax:501-941-1703
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1624816OtherUNITED CONCORDIA PROVIDER